Provider Demographics
NPI:1184881989
Name:MARIANI, EVELYN (MS RD)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:MARIANI
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 KINGSLEY CT
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-3018
Mailing Address - Country:US
Mailing Address - Phone:914-400-9345
Mailing Address - Fax:
Practice Address - Street 1:125 BUSINESS PARK DR STE 150
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6322
Practice Address - Country:US
Practice Address - Phone:315-235-2540
Practice Address - Fax:315-235-2171
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NY008038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered